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Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009

Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009. Mike Martin Partnership Improvement and Outcomes Division. The changing shape of Scotland’s population. Some headline projections. Scotland’s 65+ population projected to rise by 21% between 2006 - 2016

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Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009

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  1. Shifting the Balance of Care (SBC)Enabling Independent Living15 September 2009 Mike Martin Partnership Improvement and Outcomes Division

  2. The changing shape of Scotland’s population

  3. Some headline projections • Scotland’s 65+ population projected to rise by 21% between 2006 - 2016 • By 2031 it will have risen by 62% • For the 85+ age group specifically, a 38% rise is projected for 2016 • And, for 2031, the increase is 144%

  4. 84% 61% 41% 24% 9% Calendar year ’07 estimate P Knight Scottish Government

  5. Community Care - Impact Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031 94% 1-9 hrs Home care 26% 10+ hrs Home care Care Home Cont h/care (hosp) Projection P Knight Scottish Government

  6. Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)

  7. What this all means for Scotland … • A new 600 bed hospital every 3 years for 20 years • A new 50 bed care home every 2 weeks for 20 years • £2.8 billion investment in sheltered housing to “stand still” • Virtually all school leavers into the care sector by 2030

  8. all this will require by 2016 22% increase in health and social care expenditure [extra £1 billion!] while 8% reduction in public expenditure* [* Institute of Fiscal Studies estimate] it just doesn’t add up!

  9. Facing the Challenges - An Outcomes Focus…………..

  10. An outcomes focus – what it means • Frail and vulnerable people supported to live at home • Control and decisions with the individual • Strong, caring, supportive communities • Fairness and equity • High quality environment • Contributing to local economy

  11. Growing old - • Not an illness; a state of being • Should we shift our focus?

  12. Current service provision by service type

  13. Current service provision by age group 65-74 75-84 85+ 97% 88% 60%

  14. Some further considerations • Tenure implications – an equity stake • ‘Young until your dead’ – self image • Economically active • Politically active and influential • Best healthy life expectancy prospects • Pension provision • Older people provide far more care than they receive

  15. Home Care – some observations • Huge variations across Scotland • 45% local authority home care staff 50+ years old • 40,000 of 65+ provide 20+ hours care per week • 3,000 65+ receive more than 20 hours per week paid care • 1:2 ratio of 10 hours and home care to care home

  16. Reshaping Care for older people ….. • Into the Spotlight Conference (Dec 08) • Lord Sutherland Review of Free • Personal and Nursing Care (Dec 08) • Ministerial Strategic Group (Dec 08-March 09) • Joint Leadership Summit (May 09) • Engagement from Now • Emerging proposals to MSG Dec 09 • Wider engagement Jan 10

  17. Reshaping Care for Older People … 8 workstreams • Vision and engagement • Care at home – a mutual care approach • Care homes • Care pathways • Planning for ageing communities • Workforce • Healthy life expectancy • Demographics and funding

  18. It has to be … outcomes • How well do our services help achieve our policy goals? • How can we help people stay out of the formal care system? • How can we support self care? • Is it a change of philosophy and approach – support not services? • We are doing it now – in pockets – what’s stopping the spread?

  19. Care at Home – some emerging ideas …… • Better integrated approaches - across health, housing and social care - across paid, unpaid and volunteer care • More anticipatory and preventative care - support to unpaid carers/volunteers - telehealthcare - “contact and connect” support • Better crisis care - appropriate rapid response - 24/7 cover - telehealthcare

  20. Develop and support volunteer and unpaid care - older people as carers - “back-up” for unpaid carers - ? Fiscal incentives (reserved matters) • More complex care at home - integrated approaches across acute, primary and social care - telehealthcare • Focus on re-ablement/outcomes/goals - rehabilitation - support to do not services done to - more personal budgets/Self Directed Support

  21. Other emerging ideas …… • Remodelling care homes to provide more specialist care • Improved ‘care pathways’ – especially in/out hospital • New models of sheltered housing – very sheltered and ‘hub and spoke’ • Promoting healthy lives – self management of long term conditions – active ageing • Building the workforce – integration across health and social care – integration across paid and unpaid and volunteers and finally – Need to model the costs and the funding options for the size and scope of care services we will need over the next 20 years

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